Provider Demographics
NPI:1912932179
Name:IRIZARRY, PABLO ENRIQUE (MD)
Entity Type:Individual
Prefix:MR
First Name:PABLO
Middle Name:ENRIQUE
Last Name:IRIZARRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 TORRE SAN PABLO
Mailing Address - Street 2:STA CRZL ST
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-7038
Mailing Address - Country:US
Mailing Address - Phone:787-780-3920
Mailing Address - Fax:787-780-2935
Practice Address - Street 1:304 TORRE SAN PABLO
Practice Address - Street 2:STA CRZL ST
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-7038
Practice Address - Country:US
Practice Address - Phone:787-780-3920
Practice Address - Fax:787-780-2935
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7425208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR98952OtherSSS